Difficulty In Initiating Sleep Research Articles

Coemergence of Insomnia and a Shift in the Th1/Th2 Balance toward Th2 Dominance

Objectives: Insomnia is associated with physical and mental disorders. We examined the effect of insomnia on immune functions, focusing on the T helper 1 (Th1)/ T helper 2 (Th2) balance, by a cross-sectional design. Methods: We provided a self-administered questionnaire to evaluate sleep habits, smoking and medical disorders to 578 men without any toxic exposure (20–64 years old), and measured natural killer (NK) cell activity in 324 men and production of interferon-gamma (IFN-γ) and interleukin-4 (IL-4) after stimulation with phytohemagglutinin in 254 men. According to the criteria of DSM-IV, in which insomnia is classified into primary and secondary insomnia, we assessed the effect of insomnia on immune functions, controlling for age and smoking in groups with and without medical disorders. Results: The prevalence of insomnia in the present study was 9.2%. In the absence of medical disorders, insomniac men had a significantly lower IFN-γ and ratio of IFN-γ to IL-4 than noninsomniac men. Men with insufficient sleep or difficulty initiating sleep (DIS) had a significantly lower IFN-γ to IL-4 ratio than those not suffering from insufficient sleep or DIS. In the presence of medical disorders, insomniac men had significantly higher IL-4 than noninsomniac men. Men with difficulty maintaining sleep (DMS) had a significantly lower IFN-γ to IL-4 ratio than men without DMS. NK cell activity was independent of insomnia. Conclusions: The present results showed a link between insomnia unrelated to medical disorders and a shift in the Th1/Th2 balance toward Th2 dominance, indicating that the relationship between sleep quality and the etiology of immune-related diseases should be reconsidered.

Insomnia is Associated with Psychological and Physical Problems in Japanese Male Workers.

Objectives To elucidate sociodemographic, lifestyle, psychological, and physical factors associated with two subtypes of insomnia in Japanese male workers.Design A cross-sectional study using the annual health examination database of a Japanese company.Setting N/AParticipants Middle-aged male participants in the 1998 health examination at an employee health management center of a Japanese company (n=22, 185) .Main outcome measures Self-reported insomnia, including difficulty initiating sleep (DIS) and difficulty maintaining sleep (DMS) .Results In the young age (<45 years old) group: Significant higher odds ratio (OR) for DIS was found in living alone, shift work, smoking, lack of having three meals, psychological problems, and hypertension, with significant lower OR in overtime work and alcohol drinking. Significant higher OR for DMS was found in living alone, alcohol drinking, psychological problems, and hypertension, with significant lower OR in overtime work. In the old age (≥45 years old) group: Significant higher OR for DIS was found in living alone, smoking, lack of having three meals, lack of exercise, and psychological problems, with significant lower OR in overtime work, alcohol drinking, and hypertension. Significant higher OR for DMS was found in alcohol drinking, lack of walk, psychological problems, and diabetes, with significant lower OR in overtime work and smoking.Conclusions Insomnia was associated with psychological and physical problems, besides lifestyles, in Japanese male workers.

Gender differences in insomnia—a study in the Hong Kong Chinese population

Objective: To study the epidemiology of insomnia in the adult Chinese population in Hong Kong and to examine the potential gender-related demographic and lifestyle factors in insomnia. Methods: A population study via random telephone survey with a structured questionnaire was carried out for noninstitutionalized Chinese adults aged 18–65 by trained lay interviewers. The questionnaire included demographic data, sleep habits and problems, insomnia symptoms and lifestyle questions. Results: A total of 9851 subjects (46.4% male; 53.6% female) were included in the final analysis. The overall prevalence of Hong Kong Chinese as suffering from insomnia during the preceding month (with a frequency of sleep disturbance of at least three times per week) was 11.9% (95% CI 11.2–12.6), including difficulty in initiating sleep (DIS) (4.5%; 95% CI 4.1–5.0), difficulty in maintaining sleep (DMS) (6.9%; 95% CI 6.4–7.5) and early morning awakening (EMA) (4.0%; 95% CI 3.6–4.4). Females were about 1.6 times at higher risk for insomnia than males. The prevalence of insomnia was also shown to increase with age. Multivariate analysis showed that unemployment, lower economic status, alcohol consumption, regular medication and psychiatric disturbance were all associated with higher risks of insomnia in both sexes. Furthermore, lower education level and being retired was associated with a higher risk of insomnia in males, but being a housewife, divorced/widowed, and complaining of a nocturnal noisy environment were associated with a higher risk of insomnia in females. Among all these factors, psychiatric disturbance was the most influential risk factor for insomnia in both sexes. The reasons for gender differences of insomnia may include their differences in the prevalence of psychiatric morbidities, symptom endorsement, gonadal steroids, sociocultural factors and coping strategies. Conclusions: Overall, 11.9% of the Hong Kong Chinese adult population complained of frequent insomnia in the preceding month. There was a higher prevalence of insomnia in females. Although there were common risk factors for insomnia in both sexes, there existed gender-specific risk factors.

Prevalence of insomnia and associated factors in South Korea

Introduction: In Western countries, insomnia is associated with daytime impaired functioning, as well as physical and psychiatric illnesses. However, little information exists on insomnia in Asian countries. This study investigates the prevalence and correlates of insomnia in the general population of South Korea. Methods: A representative sample of the South Korean general population composed of 3719 noninstitutionalized individuals aged 15 years or older were interviewed by telephone using the Sleep-EVAL system. The participation rate was 91.4%. The interviews covered sleep habits, sleep symptomatology, physical and psychiatric illnesses. DSM-IV sleep and psychiatric disorder diagnoses were also assessed. Results: Insomnia symptoms occurring at least three nights per week were reported by 17.0% of the sample; difficulty initiating sleep (DIS) was mentioned by 4.0% of the sample, difficulty maintaining sleep (DMS) by 11.5%, early morning awakenings (EMA) by 1.8%, and nonrestorative sleep (NRS) by 4.7% of the sample. DSM-IV insomnia disorder diagnoses were found in 5% of the sample. Over 50% of subjects with insomnia symptoms reported important daytime consequences and another 20% reported mild or moderate consequences. However, the proportion of insomnia subjects seeking medical help for their sleep problems was very low (6.8%). Conclusions: As in Western countries, insomnia is widespread in South Korea, affecting nearly one in five individuals. Many of them would benefit from medical help; however, few insomnia subjects are consulting for this problem. An educational effort is needed for both the general population and the physicians.

Residential Exposure to Power Frequency Magnetic Field and Sleep Disorders Among Women in an Urban Community of Northern Taiwan

To investigate relationships between residential exposure to power frequency magnetic field and sleep initiation and maintenance disorders (SIAMD). A cross-sectional design conducted in an urban town of northern Taiwan in 1995-1996. A total of 5,078 married women aged 20-59. N/A. The residential magnetic field intensity was assessed using EMDEX II dosimeters. Trained interviewees collected self-reported information on SIAMD and other covariates. Three type-specific SIAMD were analyzed for associations with background, bedroom, and overall residential exposures. The prevalence rates of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) were 29.5%, 38.17%, and 26.02%, respectively. The DIS prevalence was significantly associated with bedroom magnetic field exposure of 2 miliGauss (mG) (odds ratio (OR)=1.20, 95% confidence interval (CI)=1.02-1.40). The DMS prevalence was significantly higher for women with background exposure of 2 mG (OR=1.28, 95% CI=1.04-1.56). An elevated EMA prevalence was also significantly associated with all of the three exposure measures with excess risks ranging from 28% for overall exposure to 65% for background exposure. When magnetic field strength was analyzed as a continuous variable, background exposure, but not overall or bedroom exposure, showed a small but significant association with DMS and EMA (OR=1.05 per 1 mG increase, 95% CI=1.02-1.09). There is a modest association between residential exposures to elevated magnetic field intensity and insomnia complaints in women.

Self‐reported sleep quality, strain and health in relation to perceived working conditions in females

Self-reported sleep quality, strain and health in relation to perceived working conditions in females The aims of this study were to examine self-reported sleep quality, perceived strain and health in relation to working conditions; the prevalence and severity of sleep disturbances and daytime distress arising from poor sleep in women on different work shifts. Furthermore, to see whether females with gastrointestinal symptoms, joint-, back- or muscle-pain and who are dissatisfied with working hours differ with regard to the above aspects. Finally, degree of strain-related symptoms and sleep difficulties were tested as predictors of sleep quality and general health outcome. Important research questions are whether registered nurses and those on rotating work shifts have greater sleep problems than others. A total of 156 females, aged 20-59 years, working at three different casualty departments, answered structured questionnaires. The results showed a persistently high rate of psycho-physiological long-term effects of stress related to working conditions. Thirty-four per cent were dissatisfied with their working hours, and exhibited significantly more mental strain, fatigue/excessive tiredness and inability to relax after work because of involuntary thoughts, in relation to working conditions than others did. Sixty-two females (39.7%) complained of insufficient sleep. The sleep quality outcome was significantly predicted by difficulty falling asleep (odds ratio 8.4), difficulty in falling asleep after nocturnal awakening (odds ratio 3.4) and perceived exhaustion (odds ratio 2.6). Females suffering from gastrointestinal symptoms and joint-, back- and muscle symptoms for several days in a week or even everyday were especially sensitive to worse sleep quality. Independent of work shifts, registered nurses exhibited a higher degree of mental strain and prolonged recovery in comparison with others. In conclusions, sleep initiation difficulties, troubled sleep and exhaustion significantly predicted reduced sleep quality outcome with decreased resilience to stress and vulnerability to psycho-physiological disorders in females working within the health care system.

Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population.

Only a few prospective surveys have been performed to investigate the relationship between sleep complaints and coronary artery disease (CAD) mortality. This study was conducted to determine whether sleep complaints in a middle-aged population predicted total mortality and CAD mortality. A population-based prospective study. Setting. The County of Dalarna, Sweden. In 1983, a random sample of 1870 subjects aged 45-65 years responded to a postal questionnaire (response rate 70.2%) including questions about sleep complaints and various diseases. Mortality data for the period 1983-95 were collected, and Cox proportional hazard analyses were used to examine the mortality risks. At 12-year follow-up 165 males (18.2%) and 101 females (10.5%) had died. After adjustment for a wide range of important putative risk factors, difficulties initiating sleep (DIS) were related to CAD death in males [relative risk (RR), 3.1; 95% confidence interval (CI), 1.5-6.3; P < 0.01], but not in females. Short or long sleep duration did not influence risk of CAD mortality or total mortality for either gender. Depression in males increased the risk of death attributed to CAD (RR, 3.0; 95% CI, 1.1-8.4; P < 0.05) and total mortality (RR, 2.2; 95% CI, 1.1-4.5; P < 0.05). These results provide evidence that there is an association between difficulties falling asleep and CAD mortality in males.

Insufficient sleep, cognitive anxiety and health transition in men with coronary artery disease: a self-report and polysomnographic study.

To explore possible links between sleep quality, cognitive anxiety and the effects of sleep disturbances on health, daytime functioning and quality of life, for assessment in a larger study. Hypotheses were: (a) patients with coronary artery disease have insufficient sleep as measured by self-reported sleep and by polysomnography, (b) self-reported sleep is associated with polysomnographically measured sleep, (c) reduced sleep quality is associated with physical and mental health, and interferes with quality of life as measured by means of interviews and polysomnography, (d) reduced sleep quality is associated with reduced resilience to stress. It has become increasingly evident that poor sleep with sleep initiation difficulties is an independent risk factor for cardiac events among men, and requires more attention in clinical nursing practice. Descriptive, correlative and explorative study. Forty-four men, aged 45-70, about to undergo coronary artery bypass surgery at a Swedish University Hospital. Interviews and 24-hour continuous ambulatory polysomnography were performed. For the interviews, the Uppsala Sleep Inventory, Spielberger State Anxiety Scale and the Nottingham Health Profile instruments were used. Seventeen patients (38.6%) had insufficient sleep and 12 had sleep initiation difficulties. Logistic regressions revealed that reduced stage 3-4 sleep predicted poorer overall health, initiation of sleep difficulties, predicted insufficient sleep and involuntary thoughts predicted fragmented sleep. Poorer quality of life was predicted by reduced deep sleep. Independent predictors for emotional distress were sleep efficiency below 85%, fragmented sleep and a daytime nap longer than 15 minutes. Objective sleep was associated with several subjective sleep variables. The results provide empirical support for significant variables included in a theoretical framework relating to sleep quality, cognitive anxiety, health and quality of life. A larger study is recommended that includes both men and women.

What are the contributing factors for insomnia in the general population?

Lack of a systematic assessment of insomnia has led to large variations in its reported prevalence in the general population. This study aims to provide new guidelines to assess insomnia prevalence. A cross-sectional telephone survey using the Sleep-EVAL system was done with 24,600 general population-based subjects 15 years and older representative of general populations (France, the UK, Germany, Italy, Portugal, and Spain) consisting of 251,405,391 inhabitants. The overall participation rate was 81.0%. Within the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptomatology for insomnia, 27.2% (95% confidence interval: 26.6–27.8%) of the sample reported difficulty initiating sleep (DIS) (10.1%) or maintaining sleep (DMS) (disrupted sleep (DS): 18.0%; early morning awakening (EMA): 10.9%) or nonrestorative sleep (NRS) (8.9%) at least three times per week; 48.5% of them were concomitantly suffering of a DSM-IV sleep/mental disorder. A factor analysis identified several variables strongly related to each of the major factors of insomnia allowing: (1) The narrowing of the definition of insomnia: the prevalence of insomnia decreased to 16.8% with 64.5% of insomnia subjects having a DSM-IV sleep/mental disorder; (2) The identification of a sleep-deprived (voluntary or not) group without insomnia symptoms, representing 2.1% (1.9–2.3%) of the sample. Interestingly, the latter group closely matched the definition of insufficient sleep syndrome as described by the International Classification of Sleep Disorders (ICSD). Using more delineated criteria to assess insomnia increases the recognition of subjects complaining about sleep. Classifications should be amended to improve the correct identification of insomnia. Sleep-deprived subjects should also not be neglected.

Prevalence of sleep disturbance and hypnotic medication use in relation to sociodemographic factors in the general Japanese adult population.

This study was the first nationwide population-based study to estimate the prevalence rates of sleep disturbance and hypnotic medication use in the general Japanese adult population. In 1997, 2,800 Japanese adults aged 20 years and over were randomly selected from the 1995 Census and 1,871 were examined using the Pittsburgh Sleep Quality Index. The respective estimated overall prevalences of insomnia (INS), difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), poor perceived quality of sleep (PQS) and hypnotic medication use (HMU) were 17.3%, 8.6%, 12.9%, 17.8%, and 3.5% in males and 21.5%, 12.6%, 16.2%, 20.2% and 5.4% in females. Among males, DIS (OR = 2.76) and PQS (OR = 2.12) were associated with never having married. DMS was associated with being 60 years and older (OR = 2.68) or divorced/separated (OR = 3.74). Among females, DMS was associated with being widowed (OR = 1.65), unemployed (OR = 1.60), 40 to 59 years old (OR = 0.57) or never having married (OR = 0.39). DIS was associated with being widowed (OR = 1.67) or unemployed (OR = 1.58). HMU was associated with advancing age (OR = 8.26-10.7), being widowed (OR = 2.12) or never having married (OR = 2.84). PQS was associated with advancing age (OR = 0.63-0.50). Our study showed sleep disturbance and hypnotic medication use were prevalent among Japanese adults and some sociodemographic factors contributed to them.

Sleeping difficulties in relation to depression and anxiety in elderly adults

This study examines the prevalence of sleeping difficulties and their relationship to depression and anxiety in 1328 subjects aged 57?79 years by means of a questionnaire. Difficulties initiating sleep (DIS), difficulties maintaining sleep (DMS), early morning awakenings (EMA), and nightmares were assessed with The Uppsala Sleep Inventory (USI) and depression and anxiety with The Hospital Anxiety and Depression Scale (HAD scale). A total of 20.4% reported severe sleeping difficulties (DIS, DMS, or EMA), with a female preponderance. On the basis of the HAD scale we found that 3.4% fulfilled the criteria for ''definite depression'' and 10.1% fulfilled the criteria for ''possible depression''. The prevalence of ''definite'' and ''possible pure anxiety'' (anxiety without depression) was 2.7% and 8.1%, respectively. There was no sex difference in reports of depression, but women more often reported pure anxiety. Altogether, 24.3% of the sample had either depression or anxiety. Nightmares were reported by 2.2% of the sample and associated with both depression and anxiety. We found that 39% of respondents with definite depression and 45.2% with definite pure anxiety reported sleeping difficulties. Depression emerged as the variable most consistently associated with sleeping difficulties when depression, pure anxiety, age, and sex were considered simultaneously. Habitual sleeping pill use was reported by 31.1% of the subjects with definite depression, whereas only 24.4% received antidepressive medication. These findings indicate that sleeping difficulties often are associated with psychiatric symptoms, especially depression.

Sleep and heart rate circadian rhythm in depression: the necessity to separate.

In order to determine whether a decrease in the amplitude of heart rate circadian rhythm (HRCR) could represent a chronobiological marker of depression and to answer the question of the possible role of this alteration in the reduction of rapid eye movement sleep latency (REM latency) observed in depression, 22 major depressed patients (DSM III R, Montgomery Asberg Depression Rating Scale) and 11 healthy volunteers entered this study, which included the simultaneous recordings of sleep and heart rate (HR) during two consecutive 24-h periods. After a smoothing procedure, the HR data, obtained from a portable device providing mean HR/min, were computed with the single cosinor method for the classical circadian parameters. We also determined the cosinor fitting index (CFI = percentage to fit). When studied as a single group and compared to the control group, the depressed patients, who had difficulties in sleep initiation and whose REM latencies were within normal limits, were characterized by a dampening of the amplitude HRCR and of the day-night HR difference. This was linked to a lesser increase of HR during the day and a reduced decrease at night. No significant phase modification of HRCR was observed in this group of depressives. In a second step, the depressives were divided into a depressed arrhythmic group (DAG, CFI < 50%, 11 patients) and a depressed rhythmic group (DRG, CFI > 50%, 11 patients) who did not differ on MADRS scores. Even though the amplitude of HRCR was reduced in the DAG only, with HR higher at night and lower during the daytime than for controls, both DAG and DRG significantly differed from controls on those items related to sleep induction and maintenance. In the DAG only was there a tendency toward a reduction of total sleep time and REM sleep time while REM latency was normal. This finding suggests that sleep problems are not responsible for the differences in HRCR parameters between the two depressed groups. These differences in HR and sleep parameters between two groups of similarly depressed patients also suggest that a short REM latency does not systematically imply a disruption of all circadian clocks.

Differences in the symptoms of men and women with obstructive sleep apnoea

In order to determine whether the clinical features of obstructive sleep apnoea (OSA) are the same in men and women we reviewed the records of 22 women with OSA. The women were matched with 44 men of similar age (+/- 5 years) and frequency of respiratory events (less than or equal to 15/hr, 16-40/hr, 41-70/hr and greater than 70/hr). The degree of daytime somnolence was similar in men and women. Women are more likely than men to complain of morning fatigue and morning headache, and less likely to report restless sleep or to have been told of apnoea during sleep. Difficulty initiating sleep (DIS) was twice as common in women as in men (p less than 0.05). Most of these differences were also seen when women and men who snored but did not have OSA were compared. Arterial hypertension was less common in women (3/22) than in men (18/44), (p less than 0.001). More striking than the differences between men and women in the prevalence of single symptoms was the existence of a subgroup of women (9/22) with no complaint of either apnoea, choking arousals or restless sleep, and normal blood pressure, complaining only of fatigue and morning headache, and in three cases DIS as well. We concluded that OSA may be commoner in women than previous reports suggest, and that the clinical features may be misleading in women.

Quality of sleep and chronic illnesses

The association between sleep complaints and chronic illnesses was investigated in several patient groups, including type-2 diabetics, patients with recent myocardial infarction, chronic paraplegia, affective disorders or rheumatic (musculoskeletal) disorders. Sleeping habits and complaints were investigated by questionnaire. All diagnoses were established by the rehabilitation team of the Rehabilitation Research Centre (RRC). The prevalence of difficulty in initiating sleep (DIS) and difficulty in maintaining sleep (DMS) was slightly higher in the myocardial infarction group than in their respective matched control group, whereas patients with paraplegia or an affective disorder suffered markedly from various sleep disorders. Patients with rheumatic illness reported sleep disorders significantly less often than patients with affective disorder, though on admission both groups complained of similar somatic symptoms and poor sleep. Organic disease per se does not explain the prevalence of sleep disorders in patients with chronic illnesses. Psychological and social factors seem to contribute significantly to the prediction of sleep disorders in patients with chronic illnesses.

Somatic Diseases and Sleep Complaints

The prevalence of sleep complaints and somatic diseases was estimated in a random sample of 4064 Swedish men aged 30-69 years. Great difficulty initiating sleep (DIS) was experienced by 6.9% and moderate problems in DIS by 14.3%. Complaints of major difficulty maintaining sleep (DMS) were reported by 7.5% of the men and of moderate DMS by 14.9%. DMS was more frequent with increasing age. Excessive daytime sleepiness (EDS) was reported by 5.7%. Altogether 879 men were attending regular medical examinations for somatic diseases. Among the 299 hypertensive men, major complaints of DMS (13.5%), DIS (8.4%) and EDS (8.8%) were more common, but the 167 men treated with beta-blockers rather showed a proportionally somewhat lower prevalence of sleep complaints. Men with obstructive pulmonary disease (n = 113) had a higher prevalence of DMS (18.8%) and EDS (12.4%). Diabetic men (n = 74) complained also more often of DMS (21.9%), DIS (21.1%) and EDS (12.2%). Men with rheumatic disease (n = 176) and obesity (n = 221) also had increased prevalence of sleep complaints.

Prevalence of Insomnia and Factors Associated with it Among the Elderly People of Sarangdanda VDC in Panchthar District

Insomnia is one of the major and unsolved problems in older people. Most of the sleep studies report that the different forms of insomnia like Difficulty Initiating Sleep (DIS), Difficulty Maintaining Sleep (DMS) and Non-Restorative Sleep (NRS) are common among the elderly that are associated to many factors. The objective of the study was to measure the prevalence of insomnia and the factors associated to it among the elderly people. A cross-sectional study was conducted among 142 elderly people of and above 60 years of age in Sarangdanda VDC of Panchthar District of Eastern Nepal. The presence or absence of insomnia and the associated factors were assessed on them by the help of interview schedule. The results were analyzed using chi-square test in SPSS (version 11.5). DMS was the most common reported form of insomnia among the elderly followed by DIS and NRS. Association between insomnia and each of factors like use of tobacco before sleeping hours, eating too close to bedtime, use of tea/coffee before sleeping hours and use of alcohol before sleeping hours were statistically significant at 95% level of confidence. Insomnia affects a large proportion of elderly and is triggered by many factors like use of tobacco before sleeping hours, use of tea/coffee before sleeping hours, eating too close to bedtime and use of alcohol before sleeping hours. Keywords: Alcohol; tea/coffee; difficulty initiating sleep (DIS); difficulty maintaining sleep (DMS); non-restorative sleep (NRS); tobacco DOI: 10.3126/dsaj.v4i0.4517 Dhaulagiri Journal of Sociology and Anthropology Vol.4 2010 pp.129-142